Fungal infections.

Fungal infections of the upper extremity are of four main types: cutaneous, subcutaneous, deep, and systemic. Cutaneous infections are caused by organisms capable of utilizing keratin. They involve skin and nails. Most respond to local therapy. Subcutaneous infections are caused most typically by Sporothrix. Diagnosis is often delayed as associated bacterial colonization may be mistaken for the primary infectious agent. Treatment with systemic antibiotics is usually successful. Deep infections are usually caused by direct inoculation of fungus into deep soft tissues. Systemic fungal infections are of two types--those that occur in normal hosts and those that occur primarily in immunosuppressed patients. For both deep and systemic fungal infections, permanent impairment is common. Diagnosis is often delayed for many months. Treatment usually requires a combination of surgical excision and systemic antifungal therapy with Amphotericin B.